CIHM 
 Microfiche 
 Series 
 (Monographs) 
 
 ICMH 
 
 Collection de 
 microfiches 
 (monographies) 
 
 Canadliin Institute for Historical Mirroreproductions / In. . .ut canadicn d>i microropro<luctions historiquos 
 
 1999 
 
 The Ir 
 copy i,vai. 
 rtiav b*^ ;.:i 
 thf,' "^^z 
 sic::,tic.ant 
 check. :,ci oi 
 
 I 1 Colo 
 
 n 
 
 Cou' 
 
 Cov« 
 Coui 
 
 □ Cov( 
 Cou\ 
 
 I [ Cove 
 
 I I Colo 
 
 I 1 Colo 
 
 □ 
 
 Encr 
 
 Colo 
 Plam 
 
 Bour 
 Relie 
 
 rn Only 
 
 Seuli 
 
 I I Tight 
 
 I 1 interi 
 
 n 
 
 D 
 
 I'omt 
 interi 
 
 BlanI 
 withir 
 omitt 
 blan 
 appa 
 poss 
 
 Addi! 
 Com 
 
 This ile.'Ti IS ' 
 Ce documeni 
 
 lOx 
 
Technical and Bibliographic Notes / Notes techniques et bibliographiques 
 
 The k te has attempted to obtain the best original 
 copy ^. v.. ..able lor filming. Features of this copy which 
 may 1-'=- : :o;i >.]raphic=;liy unique, which may alter any of 
 thf "TTOS in the reproduction, or which may 
 siG:;.tic.antly cnange the usual method of filming are 
 chectv/j oelovv 
 
 □ 
 
 Coloured covers / 
 Couverture de couleur 
 
 I I Covers damaged / 
 
 Couverture endommagee 
 
 □ Covers restored and/or laminated / 
 Couverture restauree et/ou pelliculee 
 
 Cover title missing / Le titre de couverture manque 
 
 I I Coloured maps / Carles geographiques en couleur 
 
 □ Coloured ink (i.e. other than blue or black) / 
 Encre de couleur (i.e. autre que bleue ou noire) 
 
 □ Coloured plates and/or illustrations / 
 Planches et/ou illustrations en couleur 
 
 Bound with other material / 
 Relie avec d'autres documents 
 
 Only edition available / 
 Seule edition disponible 
 
 Tight binding may cause shadows or distortion along 
 interior margin / La reliure serree peut causer de 
 I'ombre ou de la distorsion ie long de la marge 
 inteneure. 
 
 Blank leaves added during restorations may appear 
 within the text. Whenever possible, these have been 
 omitted from filming / II se peut que certaines pages 
 blanches ajoutees lors d'une restauration 
 apparaissent dans le texte, mais, iorsque cela etait 
 possible, ces pages n'ont pas ete filmees. 
 
 Additional comments / 
 Commentaires supplementaires; 
 
 D 
 
 D 
 
 D 
 
 L'Institut a microfilme le meilleur exemplaire qu'il lui a 
 ete possible de se procurer. Les details de cet exem- 
 plaire qui sont pout-etre uniques du point de vue bibli- 
 ographique, qui peuvent modifier une image reproduite, 
 ou qui peuvent exiger une modification dans la metho- 
 de normale de filmage sont indiques ci-dessous. 
 
 Coloured pages / Pages de couleur 
 
 I I Pages damaged / Pages endommagees 
 
 n 
 
 Pages restored and/or laminated / 
 J Pages restaurees et/ou pelliculees 
 
 Pages discoloured, stained or foxed / 
 Pages decolorees, tachetees ou piquees 
 
 □ 
 
 I Pages detached / Pages detachees 
 
 ,' Showthrough /Transparence 
 
 I I Quality of print varies / 
 
 n 
 
 n 
 
 Qualite inegale de I'impression 
 
 Includes supplementary material / 
 Comprend du materiel '".upplementaire 
 
 Pages wholly or partially obscured by errata slip' 
 tissues, etc., have been refilmed to ensure the be".i 
 possible image / Les pages totalement ou 
 partiellement obscurcies par un feuillet d'errata, une 
 pelure, etc., ont ete filmees a nouveau de fagon a 
 obtenir la meilleure image possible. 
 
 Opposing pages with varying colouration or 
 discolourations are filmed twice to ensure the best 
 possible image / Les pages s'ooposant ayant des 
 colorations variables ou des decolorations sont 
 filmees deux fois afin d'obtemr la meilleure image 
 possible. 
 
 This ilc:n :s Mmed at !t-,e reduction ratio checked lielov* / 
 
 Ce document pst tilmc au taux de reduction indique ci-dessous 
 
 lOx 
 
 14x 
 
 18x 
 
 12x 
 
 16x 
 
 20x 
 
 22x 
 
 26x 
 
 30x 
 
 24x 
 
 28x 
 
 32x 
 
The copy filmed here has been reproduced thanks 
 to the generosity of: 
 
 J.J. Talman Regional Collection, 
 D.B. Weldon Library, 
 University of Western Ontario 
 
 The images appearing here are the best quality 
 possible considering the condition and legibility 
 of the original copy and in keeping with the 
 filming contract specifications. 
 
 Original copies in printed paper covers art filmed 
 beginning with the front cover and ending on 
 the last page with a printed or illustrated impres- 
 sion, or the back cover when appropriate. All 
 other original copies are filmed beginning on the 
 first page with a printed or illustrated impres- 
 sion, and ending on the last page with a printed 
 or illustrated impression. 
 
 The last recorded frame on each microfiche 
 shall contain the symbol — *► (meaning "CON- 
 TINUED"), or the symbol V (meaning "END"). 
 whichever applies. 
 
 L'exemplaire film^ fut reproduit grace A la 
 g^n^ijsit^ de: 
 
 J.J. Talman Regional Collection, 
 D.B. Weldon Library, 
 University of Western Ontario 
 
 Les images suivantes ont 6t6 reproduiies avec le 
 plus grand soin. compte tenu de la condition et 
 de la nertet6 de l'exemplaire film*, et en 
 conformit* avec les conditions du contrat de 
 filmage. 
 
 Les exemplaires originaux dont la couverture en 
 papier est imprimAe sont film^s en commencant 
 par le premier plat et en terminant soit par la 
 derniire page qui comporto une empreinte 
 d'imprf ,sio" ou d'illustration, soit par le second 
 plat, s f jn le cas. Tous les autres exemplaires 
 originaux sont film*s en commenpant par la 
 premiere page qui comporte une empreinte 
 d'impression ou d'illustration et en terminant par 
 la derniAre page qui comporte une telle 
 empreinte. 
 
 Un des symboles suivants apparaitra sur la 
 derniAre image de cheque microfiche, selon le 
 cas: le symbole —^ signifie 'A SUIVRE ', le 
 symbole V signifie "FIN ". 
 
 Maps, plates, charts, etc., may be filmed at 
 different reduction ratios. Those too large to be 
 entirely included in one exposure are filmed 
 beginning in the upper left hand corner, left to 
 right and top to bottom, as many frames as 
 required. The following diagrams illustrate the 
 method: 
 
 Les cartes, planches, tableaux, etc.. peuvent etre 
 filmAs A des taux de reduction diff^rents. 
 Lorsque le document est trop grand pour etre 
 reproduit en un seul cliche, il est film^ ^ partir 
 de Tangle supArieur gauche, de gauche ^ droite. 
 et de haut en bas, en prenant le nombre 
 d'images n^cessaire. Les diagrammes suivants 
 illustrent la m^thode. 
 
 1 2 3 
 
 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 6 
 
MICROCOPY REiOLUTION TEST CHART 
 
 ANSI and ISO TEST CHART No 2l 
 
 1.0 If 
 
 I.I 
 
 1^ 1 2.8 
 
 32 
 
 36 
 
 2£ 
 1.8 
 
 1.25 i 1.4 mil 1.6 
 
 js APPLIED INA^GE Inc 
 
THE DIAGNOSIS AND 
 
 TREATMENT OE 
 
 ACID(3SIS 
 
 15V 
 
 1. I ' IvOV.N !!M I \\ 1) 
 
 |•«o^^:ssoK or mk')!C!N!- iM\iks:v, >)i minmsuta 
 
 MI\M-\I'M| K \\|\\ 
 
 «.litint,>l li,,m ll„ M I'M I \1M'I, \| KirVNM |.,,nM'> imI 
 
 \i»i.K>/.IJ I I .\(, I'l'MMINi, cu 
 
 Ci)rnti Thinl .iiul J.Kksun Sirtds 
 
 ST PAl'l MINN 
 
 I'll; 
 
i 
 
 
 at«i 
 
 ft 
 
lRpiirinli>d rom Tin; ST, I'Afl, Mf:i):CAI. .lOURNAr,. 
 
 .!:inw;irv. 1917 t 
 
 •UK DIACXdSlS A\J) TJiKAT.MKNT OF 
 ACIDOSIS.^ 
 
 i 
 
 L. (.'.. RowNTKi-j;, M. D.. 
 
 Proft^ssor nf M.cli.. '1h\ riii\. r-ii>- uf .Minm.cotii. 
 
 Miiiiu-apolis. Mi)i!i. 
 
 Tlicori'tically ;ni(l |)rai/ticaliy acidosiH is (if 
 '■xtrciiK' interest: 1o the scientist, on account of 
 llif inpcnions protective iiieclianiMus furnislieil 
 liy nature to maintain an aeiij liase ei|uilil)riuni : 
 to the clinician, on account of its freiiucut oc- 
 curi'cncc in many clinical ■■onditions. 
 
 iu'cenlly newer methods have heen intro- 
 durcl which make possible an earlier and more 
 preeise diagnosis of acidosis and throw consid- 
 erable lii,'ht up(jn the mechanism whereby the 
 condition arises. 'Hie mon' I'eady clinical diag- 
 nosis of an\ [lathoiogic condition naturally 
 leads to a moi'e successful ti'eatment, and an 
 understaniiing of the mechanism whereby it 
 arises leads towards successful priijihylaxis and 
 rational therapy. 
 
 The priiblcm ot' aiddosis is embraced in the 
 much large]' one of the maintainance of the 
 acid base eiiuilibi-ium in the liody. There are 
 diii'erent types of addusis. ench being depend- 
 ent perhaps, to a very gr.'at extent, on the clin- 
 ical associations iu which we find it. So far as 
 1 can rerall. 1 have never sr(>n or reail ol' a case 
 of primary idiopatliie acidosis. it is always 
 seeondar.x. It arises in many clinical condi- 
 tions, some of \,liirh We will diseuss later, and 
 the ditt'erent elinieal assiiei;itions control to a 
 
 •Ue.id tiHturi- Oie Snuiheru Miuiir-.ti Mi>,lir«l .\ssnciKti.jii h: 
 KocUdKr. Minii Aagu'ti M. Itlie. 
 
 ii 
 
e 
 
 lar^'c extent the (liffcrent matiifcstalions whicli 
 we may tiiid in acidosis. In oilier words, aci- 
 dosis liecoiiies a part of various vicious eireles, 
 and we iiave to consider acidosis alone and in 
 association with the other elenn'nts concerned 
 in these vai'ious circles. 
 
 That ditVerent types of acidosis e.xist is very 
 evident wlicn once we begin to study tlie sub- 
 ject. Altli(»u?li there has been a tremendous 
 amount written concerning it. there has really 
 been very little added that is fundamental in 
 character since the masterly presentation of the 
 subject ))y Henderson in 1009.' A great deal 
 has been done which is not fundamental, but 
 which deals with methods of determining aci- 
 dosis and with its clinical associations. These 
 are the lines along which progress has been 
 made since Henderson's coiitribution. 
 
 In connection with acidosis we want to con- 
 sider for a moment the sources of acids as they 
 occur in the body. Tiiese are indicated in 
 Table i. 
 
 TABLK 1. 
 Origin of Acids in Living Organisms. 
 
 H.SO.-'Oxidation of S of proteins. 
 H,HO —Oxidation of I^ of .iroteins. 
 H CO3 or CO. — Oxidation of organic matter from or- 
 ganic acid. 
 Lactic) 
 
 Uric ) excr eted as such in small amounts. 
 Food — amino acids, etc. 
 
 Let us consider next tlie mechanisms pro- 
 vided by nature for taking care of the acids as 
 they accumulate from metabolism or as they 
 are taken into the body. The most important 
 acid, I should say, is the carbonic acid. The 
 carbon dioxid arises from oxidation. Its seat 
 of highest tension is in the tissues. It is trans- 
 ported from these seats of high tension to seats 
 of lower tension by the plasma and cells of the 
 
 2 
 
 r> 
 
liliioil. Till' carlion ilioxid is taken iii) l)y the 
 NailL'O, of plasma, is trausportod from tiio 
 tissues to tiie blood stream, thenee to t.ie lungs, 
 from the lungs to the alveolar air, and from the 
 alveolar air to tiie outside air. 
 
 The second big factor we have to consider is 
 the urinaiy secretion. The important part the 
 kidney plays in the I'revention of acidosis has 
 only recently been recognized. The blood is 
 constantly alkaline, not markedly, but definite- 
 ly so, and the kidney separates out from that 
 lilood a urine which is definitely acid. It ex- 
 cretes large quantities of acid. If the urine is 
 titrated back, from tlie standpoint of its ability 
 to take care of alkali, its acidity is \'>and to 
 vary from 200 to 800 e. c. of N acid. 
 
 1 want to sho.v you by means of equations 
 two or three reactions which occur in the body 
 and vhieh are a part of the mechanism for tak- 
 ing care of the acid. 
 
 \aIICO= -f IICl =- NaCl + HO— CO.. We 
 have here sodium bicarbonate: if hydrochloric 
 acid is added we get a neutral .salt which is 
 excreted by the kidney while the COj resulting 
 is excreted by the lungs. This, according to 
 Henderson, is the first line of defense of the 
 body against acid. 
 
 The second equation 
 
 Na2HP04 + HCl=NaCl=NaH2P04. 
 
 shows another type of reaction. AVe obtain the 
 acid phosphate which takes care of a consider- 
 able amount of acid, but in itself it is not 
 markedly acid, and NaCl a neutral salt. 
 
 By the third reaction 
 
 Na2HP04 + H30fCO. = NaHiP0 4 + NaHC03 
 
 we not only get rid of the acid, but we actually 
 save the alkali for tlie tissue. There is formed 
 
% 
 
 ;in ;iciil |ili(is|iliiil(' wliicli is oxiTftril in tin' 
 mini' ;niil sddiuiii Iticarlioiuiti' wliii'li is riMaiiii'il 
 ill till' lilood, pai'tii'iiiiii'ly in tiic hlood plasm. 
 'I'lic NallCO is ilic iiiosi iiii|iiirtaiit constitui'iit 
 ol' the lihiDi! plasma so I'ar as llir coiiiliat inj^ ol' 
 acidosis is eoncei'ni'd. 
 
 'I'll*' tliii'd fai'liir is tlie hiilTer [)roperty of 
 lilooil. l'>\' liiiI'lVi' wi' mran ili:' property ol' a 
 lliiid whcrcliy ii takrs rari' of coiisiderahlt' 
 i|iiaii( itii's III' I'ilhcr arid or alkalirs witliont it- 
 srit miili'i noiiiii any iioi ii'i'alilf clianj,'!' in ri'- 
 
 arlioii. Wi- li;i\i' SUrIi a tluid ill till' hlood. Wi' 
 ran add to tlh' lilood very lar!.'i' ipiant itirs of 
 lillirr acid or alkalies \vitii(nit changing its 
 ariiial lead ion. That is iiroiight about by 
 three I'aetors. l-'ii'st. by till.' carbonates and 
 biearboiiales ; seeoiid. |'!iospliates. jia rticulai'ly 
 sodium and potassium jihosphates : aiiil third 
 and liiiall>\ llic pr.iieiiiN. These three fador^ 
 pla,\' ail iiiipori.iiii ruh' in making up the' bulVer 
 \ alue ol' the blood. 
 
 TAIU.E IT. 
 Summary of Buffer Values.* 
 
 No. '.f ■•:t.e> ;iiil1 
 'I'Mcriiiiii.i' iiMi> 
 
 < 
 o.lS 
 
 o.lS 
 
 o 
 
 24 
 
 0.36 
 
 
 ' 9 
 
 0.075 
 o.lO 
 
 o,05C 
 
 0.13 
 
 9 16 
 Acidosis 
 
 24 
 
 p 
 
 Coiiiiien- 
 
 O.lO 
 
 O.20 
 
 safpd. g 
 
 1 
 
 •For method of detfrminintr Hyilroffcn Ion concen- 
 tration and bufftr value of the blood s. o articlo;-. by 
 I.fvy. Kownlrec and M.inioit. Airh. Int. Med., s-'iit. 
 1915, p. 389. 
 
 I,i\\- and nowntrcc. .\icti. Int. Mel,, .\eril, I'.iHi, ji. '.rl'i. 
 
 <l 
 
"V 
 
 lu this tahle is shown some work wliiuh in- 
 dicates that the blood and plasina lose their 
 power to taki care of aeids and alkalies in aci- 
 dosis. In carrying out this work we added to 
 a certain quantity- ' ■ ..3 a iixod quantity, 2 
 c. c. of blood or plaf ■ncre^-sin^' amount of 
 
 •J acid and alkali. 
 
 In acidosis the blood itself, in vitro, is less 
 ,11 liable of takint? care of either acids or alka- 
 lies witlout undergoini; change in reaction. 
 
 Finally the k .t protective mechanism is the 
 in'oductiou of ammonia. This we are apt to 
 think of as one of the most fundaiDcntal pro- 
 cesses, but it does not play so important a part 
 in a large number of cases. It is important in 
 the types of acidosis in which we have aceto- 
 nuria. We may have tiie most extreme grades 
 of acidosis under certain conditions, particu- 
 larly in neiihritis, without the slight.-st change 
 in the ammonia. 
 
 Table HI indicates the various tests which 
 have been used. I am showing a large number 
 ard will call attention to the more important 
 of them. Certain of these tests can be dis- 
 carded. 
 
 TABLE III. 
 Urinary. Alveolar Air. Blood. 
 
 NH,N— amount. jCO, content. 
 
 — % of TnPN.Haldane— art. 
 Acetone bodies- I'lesch— venous 
 
 amount. Fridericia— art. 
 Alkali tolerance. Flesc h-Levy. 
 
 Sellards. 
 
 Palmer & 
 Henderson. 
 
 Sensitiveness of 
 respiratory 
 centre. 
 Peabody. 
 
 Hydrogen-ion con- 
 centration. 
 
 1. A. Hydrogen 
 electrode. 
 
 B. Dial— Indi- 
 cator. 
 
 2. Alkaline re- 
 serve — 
 Van Slyke. 
 
 3. Titratable al- 
 
 kalinity. 
 
 4. Buffer value. 
 
 5. Curve of Hb 
 
 dissociation. 
 
 6. Acetone bodies. 
 
 Marriott. 
 5 
 
 Marriott. 
 
]. Urinary Studies. The ammonia nitrogen 
 of the urine. I'ln' ii mount exereted is iiiereased 
 in all cases where there is a marked acetonu- 
 ria. It is not an essential feature of acidosis. 
 We can have an extreme grade of acidosis with- 
 out any elian^'e whatever in the acetone bodies 
 in the urine. "We must draw a strong distinc- 
 tion between aeetonuria or ketonuria and aci- 
 dosis. The terms have been used synonymous- 
 ly, and on that a 'eount have led to mistaken 
 ideas in medicine, but wo must draw a sharp 
 line between them. 
 
 Acetone bodies. In certain types we do have 
 tliese aci ;onc liodies in the urine, and when 
 dealing with starxatiou or diabetes it is impor- 
 tant to know about Ihem, l)ut aeetonuria is not 
 au essential feature of acidosis, as we liave 
 already indicated. 
 
 Alkali t*"-' "ance. Tiiere are two tests — Sel- 
 lards'- and raimer and Henderson's.' Sellards 
 found that, in tiie normal individual, ten grams 
 of sod'um 'licarbonate cause i tiie urine to be- 
 come alkai, in reaction. In other words, the 
 tolerance is a|iproximately ten grams before 
 there is any cliange in reaction. He found that 
 in a large lu'reeutage of eases of acidosis this 
 did not occur: tlial SO lo 100 grams might be 
 necessary before a elianire in reaction oecurred. 
 Palmer and Hi'nderson determined the amount 
 of change in reaction of urine folh)wing the 
 ailiiiinistratioii of 4 gms. of XallCO^ liy UiOuth. 
 
 The Hydrogen Ion Concentration of the 
 Urine. The variations in normal individuals, 
 Hs fouiiil by Henderson and Palmer, arc great. 
 Imbed they niay be as gi'eat as in acidosis 
 cases; so great tiiat 1 do nut helieve the test is 
 of any great clinical value. 
 
Both of these tests aie at fault wlieu it eoiues 
 to the study of renal eases in whieh tliey liave 
 been applied. I do not believe they should be 
 used in renal eases l)eeause tliey are misleading. 
 "We know that in nephritis the kidney fails to 
 excrete a great many substanees. It may be a 
 dye substance: it may be nitrogen: it may be 
 salt, or water. We cannot take the failure of 
 the urine to become alkaline on tiie administra- 
 tion of a certain amount of alkali as an index 
 that acidosis exists, because it may be purely 
 and simply an index of renal in.sufliciency, and 
 the renal insufticiency may be of an extreme 
 grade without the Blightesl acidosis. These 
 tests, therefore, cannot be applied in cases with 
 renal insufficiency, but they may be used to 
 great advantage in conditions siich as diabetes. 
 
 2. Respiratory Studies. Alveolar carbon 
 diaxid. Several metliods have been introduced 
 to determine the alveolar CO.-. I sliall discuss 
 briefly the relative merits and the case of appli- 
 cation of some of these methods. 
 
 The determination of the alveolar carbon 
 dioxid is one of tiie most important things in the 
 study of acidosis. Some one of tlicse methods 
 ouglit to be used or be replaced bv the method 
 of Van Slyke. which determines the ability of 
 tiie lilood to take ui) CO.. Ilaldanc'.s method 
 (4) and the Fredericia method (5) give in real- 
 ity tlie tension which exLsts in the arterial 
 blood. The method of riescli ((5) differs from 
 llaldane's and Fridericia's in that the patient 
 rebreathes. Instead of breathing into a tube, 
 collecting the alveolar air at the end of expira- 
 tion, the patient rebreathes and coiisccpiently 
 the carbon dioxid tension corresponds to that of 
 the venous blood rather than that of the ar- 
 terial blood. 
 
• 
 
 Dr. Ia'v.v, \vl)ii workt'd with lai' last year in 
 lialtiinori', tricil to make tlie method of Pleseh 
 luoi'.' <;viiernii.v api'lieahle. and I liave here 
 iustniineiit wlifli demonstrates his method of 
 enlK-tiny: the alvrohir ear'non dioxid utilizing 
 tlic prim-iph' of rehreathinfr. 
 
 j'l'ahudy i7^ has called attention to the in- 
 creased sensitiveness of the respiratory centres 
 in aci<losis: in (itiier words, rehreathing; or in- 
 creasine- the earlion dioxid tension of inspired 
 tr'iiiendiiuslv increases the 
 
 an' 
 
 rate and 
 
 dejith (if I'csjiiration in acidosis as compared 
 witii the normal. Tiie sensitiveness of the res- 
 piratory centre is greatly increased in aeidosis. 
 Tills is true in tin' majoriiy of eases, hut tins 
 elTecf may he overshadowed hy tlu' influeiiee of 
 certain tliseases or dnigs which do not stimulate 
 lint jiaralyze the I'esiiiratory centre. 
 
 In any study of acidosis we iiave to consider 
 some one of these nu'thods. In our work we 
 have tised the riesch-Levy method of collecting 
 the alveohir earlmn dioxid. wi'h the Ilaldane 
 determination. The ohjection to the l'"ridericia 
 api>aratus is that with this instrunu'nt air can- 
 not he satisfactorily collected from the iiatient 
 except with intelligent coii|ieration. One can 
 make a collection hy the JMescli-Levy metiiod 
 and the determination of CO: by the Friderieia 
 apparatus. Tahle IV shows the results of a 
 series in which both the l'"ridericia and Ilaldane 
 determinations were made. 
 
 These are all indirect methods of studying 
 acidosis. Tliey \vere introduced because of the 
 great technical ilifliculty standing in the way 
 of direct methods of investigation of the blood. 
 
 :> Blood Studies. We speak of acidosis, but 
 know absolutely nothiiig coiicerniiig the condi- 
 tion of (he tissues The neai'cst we can come 
 
 8 
 
TABLK IV. 
 Comparison of Fridericia and Haldane Methods of De- 
 termining Alveolar CO. with Plesch-Levy 
 Collection. 
 
 Case 
 
 Hosp. 
 No 
 
 'reiiil'. 
 
 fridericia Haldane 
 mm. Hg. , mm.Hg. 
 
 Hi'iiKirki 
 
 ~C — I 8455 
 
 22 
 P— I 836Sr]^ 
 
 ir48fn~2^2 
 
 i 29. S I 2'J.t; , Pregnancy at lerm. 
 1 22.3 1 21.9 9 days post partuni. 
 
 22~~|"ljr3'r30j2|^aybj)osti)artuni. 
 '22Y^[22^Q~\1 days post jiartuni. 
 
 S^== — fl!498~|^22 T 4«.6~^f40.4 ,12days post partum. 
 
 B^n^8508 f 22 135.2 134.8 ,9 days post partum. 
 
 H— "^1 8522 I 22 | 35.3 I 35.00, ludayspo^tjmrtuui. 
 
 -qZ: V~ZZ j~23 I 47.9 I 47. 4 Noniial. 
 
 23~ I 44.3 I 44.0 |NoiiJial. 
 
 "^23 r 49.2" i~48. 9'|Nornial. 
 
 Z— I — 
 
 G— I - 
 
 to till' .stilt.' Ill' llif tissues is Ihi' lil'iod aifl 
 pluMua. We .■ousi.l.T tiiat llic blond rctlorts 
 eondiliuns iis tliuy .-xist in llie tissues and tins 
 atVonis tlu; uh.sI din'rt liii.' of approacii \n tin- 
 invi'st ligation ol' acidosis. 
 
 Tlicre aro a great many met hods that have 
 been used. First, the liydrogen ion eoneentra- 
 tion of the l>lood by the jras ehain luethod. 
 Tills is earried out with a llyd^o^'en ele.lrude. 
 It re(|uires an v\V ■ i\e pieee of apparatus and 
 a man trained In physirs to use it. In other 
 wonis, it is absolutely impraetieal as a elnneal 
 method. I.at.-ly we have introdueed a substi- 
 tute -a simple meth.Ml of Kettin<r at the hydro- 
 iivn ion eoneeiilrati.H) of the Mood, whieh 1 will 
 
 demonstrate. 
 
 We have a systrm of pluisphale mixtures 
 whieh vary m Uieir alkalinily. The more al- 
 k;iline (Mies are colored red. the less alkaline 
 and acid tul-es yellow sulph.uieplithalcin beintr 
 used as an iiidi. .itor. We liav a j,'radual 
 transition from the yellow until we f,'et to the 
 red. Now each mi.xlurc has a detinitely known 
 bydroK'eii iou concentration. When we want 
 
 9 
 
lo dcteniiiiu' the liydrogeu ion concentration of 
 'hlooil we i>laee two or tlirco cc. oi" blood in one 
 of tlh'se collodion tubes, place that tube in a 
 siiiail j:iass tulie containing salt solution, leave 
 it for Tt-S minutes and Mien rei.iove it. Dialysis 
 occurs friiiii the lilood tiiroufrh the -Dllodion tube 
 into tiK' salt solution. We now add an in- 
 dicat.)!-. rhenolsulpiioneplithalein will yield 
 ■.,iic (if the colors of the scale, i. e., the hydro;,'en 
 ion concentration. 
 
 Whereas it took one to two and une-half hours 
 to make a dctcrminatiun with the old method, 
 we have made as many as forty determinations 
 
 r.M'.id': V. 
 
 pH Determined by Electrometric and Dolysis- 
 Indicatur Methods. 
 
 No. 
 
 MHtert&l 
 1 .S cc. 
 
 |,M 
 
 Ct)j IKN-loN 
 
 Kl»"i-t. 
 
 Diiil. Iiid. 
 
 1. 
 2 
 
 3. 
 4. 
 5. 
 
 plasma 
 
 IiUisniu 
 lila.'^niu 
 plasma 
 plasma 
 
 1% 
 
 3% 
 
 5% 
 
 10% 
 
 10% 
 
 8.05 
 
 7.9 
 
 7.G 
 
 7.43 
 
 7.4 
 
 8.1 
 7.9 
 
 7.i; 
 
 7.1 
 7.4 
 
 Experimental Data. 
 
 Dog. 
 
 la. 
 b. 
 c. 
 
 11. I 
 
 lUa. 
 
 b. 
 
 Wl, kft. 
 
 "I'lTl" 
 
 11.8 
 17.1 
 
 Couiliiiiin 
 
 Nciiiniil 
 
 ir.o cc. iiHCl. 
 
 ISO cc. 8% 
 
 NaHCO, 
 
 4t)5 <c. S% 
 111 shock 
 Normal 
 In '-liocU 
 
 pit. 
 
 Elret. 
 
 Dliil.-Ind 
 
 7.5 
 
 7.5 
 
 .6.8 
 
 6.S 
 
 7.5 
 
 7.5 
 
 7.7* 
 
 7.6.-.*» 
 
 7.2 
 
 7.15 
 
 7.4 
 
 7.4 
 
 7.2 
 
 7.15 
 
 Clinical Data. 
 
 I'll 
 
 I'utlvnt. 
 
 Il"i<p. Nil. 
 
 Klect. 
 
 i= 1 
 
 8- I 
 
 8140 
 8234 
 823« 
 
 1.0 
 
 7.5 
 7.6 
 
 Dlitl.- nd. 
 
 7.45 
 
 7.5 
 
 7.6 
 
 •Kleclroinwtrlc method on nrtorlal tilood. 
 ♦♦Dialysis Imlicat' r mullui'l on Ncnoiis blood. 
 
 10 
 
in one afternoon with ^ 's little apparatus. 
 Y^hm iirst introduced, we elaimed only relative 
 values lor this method. ^Ve now claim that it 
 gives ahsolute values for hydrogen ion concen- 
 tration Since coming to ^linneapolis, m col- 
 laboration with Dr. J. F. McClendon, 1 have 
 iKul tlu- opportunity of comparing the results ot 
 this method with those of the eh'ctrometric 
 method. The results are given in Table V. 
 
 The alkaline reserve of Van Slyke, This 
 nut hod was introduced a year ago. It is the 
 ,uost d.licat.. ami the most valuable of any 
 sin.'le test for acidosis. It can be applied with- 
 out nuich techni-al diflirully, but requires the 
 Van Slyke aiiparatiis. 
 
 The titratable alkalinity. Tlds is a test which 
 is applied without any siKcial apparatus but it 
 is o.ilv a .-MOSS test. An alcoliol.c tiltrate of 
 |,l„od'or plasiuu is cvaporatrd in a poivrlain 
 l„nvl. ;.n indicator— phenoli«hthalein— being 
 ji.l.Ud. This .letermiues whetlicr or not the 
 solution turns red or not during evai.oration 
 ami the p-int at whi.di the red api^ears. Ad- 
 vantage IS taken of the variations in dissocia- 
 tion of the salts in water and alcohol. It is a 
 simple gross method, applicable without any 
 sp.rial appariitus. 
 
 ■n„. bullVr valur 1 have alivady discussed. 
 Iniisuiueli ;is it is not constantly decreased in 
 .-very rase ui neidosis, nsasingle test it is of no 
 
 great value. 
 
 Till- .urve (if the heiiiogbduii dissociation was 
 „„roduee,l i.v P.,ncrol-t .S . 1 have not had 
 ,„u.-i, ,s|.,,,cnee Nvllh d. It is teehnieally .lil- 
 
 lieldt. 
 
 ■n„, acetone bodice in the Mood eells can lie 
 ,l,.(,oMnined I.v methods uitrodu. ed by Si'lialVer 
 and Mainntt (!•;. 
 
 11 
 
• 
 
 Terminology. 1 iiiighl say a word about the 
 toniiiuolosiy. At the present time tliere is no 
 term in met'liral literature whieh is more loosely 
 used than acidosis. AVe should try to have a 
 elear-L-Ui (•(Uieeption of acidosis. From a labor- 
 atory point of view this is essential. In acid- 
 osis there is a decrease in the alkaline reserve, 
 in the bicaflmnate foutcnt of the blood as deter- 
 mined liy the Van .Slyke. Associated Mitii this 
 we have a decrease in llie carbon dioxid of the 
 alveolar air. If we have this occurring while 
 the protective mechanisms are suflicieut to pre- 
 vent an actual change in the hydrogeu ion 
 concentration, the condition is one of compen- 
 sated acidosis. l>ut if an actual change in reac- 
 tion occurs, i. e., a hydrogen ion eoncenti'ation 
 just about normal, the condition is one of true 
 acidosis, for wc have passed tlie stage where 
 protective iiiechanisais suflice. This termino- 
 logy is much the sanu' as is used by llasselbalch. 
 
 Clinical Aspects. The mo.st imiiortant single 
 cluneal e\ ideuce of acidosis is hyiierpnoea (air 
 liunger . It should always suggest acidosis, 
 but it does not always prove it. 1 have seen 
 delinite, iiniiiisl.iUablc hyperpuoea in alkalosis, 
 (increased alkalinity of the blood i. Ketonuria 
 or acctouuria and "acetone on the breath" are 
 also !in|ioitant. They develop in certain types 
 of cases, jiarticulariy in patients with diabetes, 
 and in st,ii\ ation. When marked, ketonuria 
 usually Hcans acidosis, but it nuiy be absent in 
 line acidosis. 
 
 Tile \'ai ions diseases in which we have acid- 
 osis is shown below. 
 
 ]. Diahetes. 
 
 'J, Kcnal. caiilioi-cnal and cardiac disease. 
 
 :i. ( 'ijriirrtic stiites siUil scverc aucmias. 
 
 4. Se\eic diarrhoea (, part ieularly in chil- 
 dren . (!()' 
 
 in 
 
 ^ 
 
5. Cholera. Sellards. (11). 
 G. Starvation. 
 
 7. rrcgiiaiicy and I'claiupsia. (12). 
 
 8. I'dst-ojierativr or i>osf-aiH'^tlH4ic ooudi- 
 
 tidtis. pai'tii-iilarly in s\u'u'ii-al sliock. 
 
 !t. Certain febrile diseases. 
 
 Diabetes. Here we t're(iiiently have acidosis, 
 with aeetone. diacctir arid and 1". oxyl)utyrie 
 acid in tlio urine, and an aeelone odor in the 
 breatli alonj,' witli air hiiniicr. Is death under 
 these eireuiiistames due to aridosis.' Aeldosis 
 is present in the majority of young eases. I 
 want to speak about this heeause thei'e is a dif- 
 ference of opinion. I doul)t whether many of 
 these patients die from the actual inei'ease in 
 hj'drogen ion concentration. Tiie aeenmulated 
 bodies, aside from changes in the reaction, have 
 mui'h to do with the outcome. I have seen pa- 
 tients with diabetic acidosis, true acidosis, to 
 whom we have given alkalies in tlie way of 
 treatment, in whom we have coiTcted tlie hy- 
 drog(>n ion concentration, brought back the al- 
 veolar carbon dioxid and the alkaline r'serve to 
 jormnl, die in typical conia. .\1)normal acids 
 in the blood and tissues may ]>lay a great role. 
 This is in keeping with the findings of Erh- 
 mann and Esser (13) which show that death in 
 coma occurs in animals \vhen thr sodium s;dls of 
 oxybulyric acid is administered id large quan- 
 tities, 
 
 T woidd like to c;dl allentioi>. to one expe- 
 rience T have had in the last three or four 
 weeks. 1 was called to see a mi'u witli an en- 
 larged |ii'ostate wiir) liad diabetes, and the (|ues- 
 tioii aiose v •;■ il-.'-r the surgeon eoidd operate, 
 he had 0.4;':; sugar in the blood— (piite high. 
 He was pitting out ^arsre (;uanlities of stigar 
 in the urine. ^Ve init him on sodium bicarbon- 
 ate, gave him .\llen"s treatment, and later kept 
 
 13 
 
liiiu v.itliiu his toliTaiicL'. An operation was 
 IJcrronued. lie developed, after operation, 
 marked !.'l\i/osiiria altliou;.'!! no extra earbo- 
 liydralrs w.re j^ivni. lie had a di'iinite aeoto- 
 nuria. llr had sonu' dia<'etie aeid, hut not a 
 trace of ai.-ido.sis. His alkaline rrscrvu, his al- 
 veolar CO., and his hydrogen ion uoneeutration 
 were strictly normal and he showed no elinical 
 signs of acidosis. Dietary control was exer- 
 cised and he made a perfect recovery. 
 
 Cardiorenal cases. Acidosis does occur in 
 certain cases of jcnal insufliciency, hut the most 
 e>i.treiue grade of uremia may exist without any 
 suggestion of it. 
 
 I M-ant to jMesent an interesting '-ase showing 
 some results in acidosis and uremia. Table VII 
 indicates the nndiiigs of a case seen in consulta- 
 tion with Dr. .Schneider of .Minneapolis. This 
 ]>atieiit rei-ei\ed alkaliiie treatment sufliei''nt to 
 correct ids acidosis hut he died. In other words, 
 it is posiMe to ceiTcet aeiiiosis witliout curing 
 reiml insuili'-ieiiev. 
 
 TAr.LK Vil. 
 
 %=\xl\fi^\t^'=^ 
 
 < S ' ' "i ' i "f oer 100 cc. ti. 
 
 4-17 
 4-19 
 
 4-20 
 
 2y.72,".2 . — j 97ji71, — , 7Vo |i\aUCU 15 
 
 I I 1 I I I iBiiis. liail.v 
 
 26.15 7.3 ,30.4 |181 .206| 24 Trace^iloO cc. 4',;, 
 
 ! I I i I ' 1-02 InuHCO, I.V. 
 
 25.67'7.5 37.57,158 ;203| 19 
 
 .1 I I 
 
 Before — i — ,24.59- | j 
 
 4.22 I ; 1 [9111711 
 
 After i — |7.6 ;26.45| | 
 
 4-24 130.4 I7.45i — I 87 il62 
 
 1.09 
 
 600 cc. i''c 
 NaHCO. 1. V. 
 
 .41 ! 
 
 Before — 7.3 t31.7 j84.5| — j — j — iTransi'tisioii 
 
 <-25 1 1 111 
 
 After |39.4 7.4 531.94 67 1 - - j — , - 
 
 • 
 
 14 
 
 <L 
 
» 
 
 1 l)elicvt; then; are a great many patients in- 
 jured witli too lari,'e quaulities of alkalies. One 
 should know what irrade of aeidosis he is deal- 
 infT Avith tlirougli lal)oratory studies. The acid- 
 osis eau l)e corrected witli alkali. You can tide 
 over c(/rtain cases. 1 luive seen an occasional 
 patient markedly iiiii)roved, but I have never 
 seen a case o!' chronic interstitial nephritis that 
 has gone on to this grade of renal insut'ticiency 
 with uremia g^'t AVt 11 or eh'ar ui) for any length 
 of time fdllowing the^coi'rection of the acidosis. 
 Acidosis is only one feature of the picture and 
 you cannot always cure tiie palii'Ut by correct- 
 ing the acidosis. 1 lia\c seen many instances of 
 marked decrease in alveolar carbon dioxid oc- 
 curring in cases of chronic interstitial nephritis 
 and iiolycjstie kidney 4 IjcIow 12 mm. llg. the 
 lowest being down to 7mm. 
 
 Cachexia. .Veidosis in cachexia was called 
 to my a; tent ion iiy a case of carcinonui of the 
 stomach, ^.itll metastasis to the li\ei\ The pa- 
 tient presented the tyi»ical pictui'e of acidosis, 
 and the anemia api'arently had little to do with 
 it. 
 
 The results of some experimt-ntal .•inemia in 
 dogs is shown in Table VI II. 
 
 
 TAl 
 
 I.K Vlll. 
 
 
 Effects 
 
 of Bleeding. 
 
 
 
 
 \vt III Aivr,.|»r 
 
 Alkii'iiiP 
 
 
 Tiiut 
 
 ,, t'<i; 
 
 U serve 
 
 
 i 
 
 ■^^"'~ 1 III iiiiii. Uii. 
 
 ill iniii. IIk 
 
 Dog 
 
 6-14-16 1 
 
 1 
 
 
 I. jBeforo bleeding 
 
 17 I 39.83 
 
 29.13 
 
 Iiuiiieiliat(-I\ 
 
 ' 
 
 
 
 after til.'rdins 
 
 
 
 
 5U0 cc. 
 
 :iivs:! 
 
 30. 
 
 
 6-ii;-ii; 
 
 k;.'? :'.8..s:! 
 
 46.51 
 
 Dog 1 6-1 1- It; 
 
 
 
 II. Before liiee.lin« 
 
 ?1.S 4it..'j7 
 
 37.38 
 
 Imnu'(liatrl\ 
 
 
 
 , alter bleetling 
 
 
 
 600 cc, 
 
 ill..'. 
 
 37.38 
 
 6-16-16 1 
 
 21.r. ; 41.e3 
 
 44,67 
 
 15 
 
 € 
 
Pregnancy and Eclampsia, llassellialch 
 rlriius tliat acitlosis is frequent iu pregnaney. 
 What is acidosis? He takes as evidence of 
 acidosis any li<.'un3 for the alveolar earhon 
 (lioxid l)elo\v 40. If acidosis does occur, it is 
 slight, as indicated by our studies. In eclamp- 
 sia, however, -we find definite evidence of it. 
 Five cases out of seven showed a d'^finite in- 
 crease in tlie hvilrogen ion concentration, i. e., 
 true acidosis. The alveolar carbon dioxid and 
 carbon dioxid eapaiMty of the blood is de- 
 creased. 
 
 TABLE IX. 
 Acidosis in Eclampsia. 
 
 Name 
 
 Date 
 
 
 ili'uinrks 
 
 K— 
 H— 
 
 B— 
 H— 
 P— 
 
 S— 
 
 H— 
 
 - \1.Z I - i - 
 .6- 9-15i7.y I — I — 
 
 |Recovery. 
 
 jT.n.F.N. 307 mgm. 
 I 1 I i jt'rea X. 2.'iG mgm. 
 
 I |Alk. toleranct; 15 
 
 i ' ! igm.+ 
 
 ,4-2S-16 7.3D'30.38| 24.67 |Dled. 
 
 '4-2!i-]t; 7.;{,")'23.02 2.5.3 Revocery. 
 
 u- 2-16,7.45; — j 33.22 I'uorperal tonvul- 
 
 I j I I sioiis. 
 
 6- 3-16! — 135. ! 34.9 'Died. 
 (i-22-167.3.5:35. I 33. ;Convalsions. 
 t;-27-16i7.5 35.3 39. | 
 
 Our scries is too small to admit of any con- 
 clusions ri'lali\e to its constancy. Kigiit cases 
 only have beex studied. True acidosis %vas 
 present in live. The lindin-.' appear iu table IX. 
 
 Acidosis in Anesthesia and Surgical Shock. 
 
 Four post-opcrati\i! cases exhibiting clinical 
 evidence of acidosis were sludii^d — two prosta- 
 tectomies, one neiihrotomy and one drainage 
 of gall bladder with bile peritonitis. All 
 showed t rue acidosis. 
 
 < 'linically we hav(> had no oii[iortuiii1.\' for the 
 study of acidosis iu relation to surgical shock. 
 
 It) 
 
In collahoratiou with Ur. J. F. Corbett,* experi- 
 mental slioek is being studied at present. Here 
 true acidosis develops as indicated by the fol- 
 lowing table. 
 
 TABLE X. 
 
 Do;; 
 
 Tinip 
 
 ^ 1 
 
 1£ 1 
 
 "H. -(.x 1 <S 
 
 Remarks 
 
 AE 910 
 
 9:30 
 l:3u 
 4:30 
 
 2r> 
 
 7.4 ]43.7 1 
 7.1 j3S.t3 I27.G 
 7.0 128.4 {32.8 
 
 
 AE 913 ' 
 
 8:30 
 
 21.8t 
 
 7.4 i."i4 ti 
 
 40.9 
 
 
 
 4:30 
 
 1 
 
 7.0 |32.1 
 
 37.1 
 
 
 AE 926 
 
 9:30 
 
 2,-.. 
 
 7.45,31.7 
 
 43.9 
 
 
 
 12:30 
 
 
 7.:i 1 — 
 
 22.6 
 
 
 
 3:30 
 
 t 
 
 7.1 :32.1 
 
 25. C 
 
 
 AE 911 
 
 9:30 
 
 18.0; 
 
 7.5 iTiiti 
 
 48.3 
 
 
 
 12:30 
 
 
 7.45'38.5 
 
 — 
 
 
 
 4:30 
 
 
 7.2 |_— 
 
 39.5 
 
 
 AE 940 
 
 S:40 
 3:30 [ 
 
 
 4:00 1 
 
 
 5:30 1 
 
 30 
 
 8:30 
 
 
 3:03 i 
 
 
 3:22 ' 
 
 
 4:05 1 
 
 1 
 
 19.1! 7.5 :56.2 54.7 j3: 2.5— 150 cc. 
 I 7.3 ]42.9 |2G.4 Ringer'f solution. 
 I 7.1 [38.0 J41.4 !3:30— 100 cc.5% 
 1 7.4 142.0 I iXaHCO,. 
 24. i 7.45 52.9 156.5 |3:03— 2U0 cc. 
 I 7.3528.9 |26.8 jHo'^an's solution 
 \ — :39.3 ]40.8 i3:22— 2u0 cc. 
 ! — |46.5 |47.9 IHogan's haemol- 
 , i ! I I ized. 
 
 The effect of XallCO^ iii)on ])lood pressure in 
 shock affords additional evidence of the exist- 
 ence of acidosis. Tracing I. is a chemographic 
 tracing showing the fall of blood pressure ac- 
 companying shock and tlie response to the ad- 
 ministration of NallCO. The effect of Ringer's 
 solution is also indicated. The second tranng 
 demonstrates le elfect of Ilogan's gelatine al- 
 kaline mixture in experimental shock. 
 
 Starvation. It is a common belief that starv- 
 ation results in acidosis. That acidosis may oc- 
 cur is not denied, but as the result of study of 
 starvation dogs we feel convinced that the role 
 of acidosis is extremely slight. Here again ke- 
 tcnuria is the more marked feature. From an 
 
 •Separate report to be published later. 
 ♦To be published later. 
 
 n 
 
Z 
 
 o 
 
 is 
 
 # 
 
I 
 
 • 
 
 19 
 
uut,-oiarletril sliuly imw in progretis in niy de- 
 pai'tmeut liy Dr. Nortiiington ;ind Dr. Grave,* 
 it ai>pear.s tliai llie role of aeidosis is almost neg- 
 ligible for t.Mi days at least in starvation. Ke- 
 tonuria iiMially develops within 48 hours and its 
 presence has been eonstrued into evidenee for 
 acidosis. Alkaline reserve, alveolar CO-, and 
 jdl of the blood remain normal for the first ten 
 days but later tiie alveolar CO^ indicates a 
 slight teiideney to decreased tension. The re- 
 sidts of these experiments are shown in tables 
 XI and XII. 
 
 TABLH XI. 
 
 e-a-j-tti to) 
 7-6-it; ) 
 
 Daii.v exams.) 
 of acetone ) 
 and diacetic) 
 
 6-14-it; 
 
 H-ir)-16; 33.1 
 
 t;-i6-i6 
 
 fi-17-18 
 
 »;-lH-16i' 33.1 
 
 6-2ii-ltii 
 
 t;-21-16 31.6 
 
 S-22-23 
 
 6-24-161 30.'. 
 
 t;.2S-16' 29. r. 
 
 fi-30-16| 28.6 I 28.47 
 
 7- 3-161 28.4 1 27.74 
 
 7- 6-16| 28.1 I 26.78 
 
 Treatment of Acidosis. Alkali treatment is 
 always indicated in acidosis, because a duiunu- 
 lion in bicarbonate reserve, as jiointetl out by 
 L. .1. licndeison. is an invariable aecompaui- 
 ii'.enl of acidosis regardless of other eo-e.\isting 
 changes. The di gree of the aei<b)sis siiould be 
 determined preliminary to the administration 
 of alkali sinei tlie degree of aeivlosis controls 
 tlu! intensity of treatment. The more severe 
 tiie acidosis tiie more alkali is iiidiea'ed. Alkali 
 sliould be administered at least until the pll of 
 the blood returns to normal. It is desirable 
 20 
 
|irrli:i|is to i-orrcct llio alvcdlni' CO- jiiid alkuli 
 rrsiTxi' ;is Well. ;ill lioii'-'ti tliis is no', alwavs so 
 rcfidily ai-c()iiii)lislii'(l. 
 
 TABLE Xll. 
 
 Date 
 
 Wt, in 
 
 < - = 
 
 <— - 
 
 V V 
 
 a c 
 
 ■<.9 
 
 — o 
 
 .1 " 
 
 Keiiiiirk-* 
 
 t;-i3-i6 
 
 16.3 
 
 42.3 
 
 46.7 
 
 
 
 Small 
 
 t;-i4-iG 
 
 
 
 
 •> 
 
 
 
 fat 
 
 iM.'i-lC 
 
 ir..4 
 
 ■:,'.K\ 
 
 40.4 
 
 
 
 <l 
 
 t'emalp. 
 
 <;-iti-i(i 
 
 
 
 
 Trare 
 
 
 
 
 ti-lT-l« 
 
 
 
 
 + 
 
 n 
 
 
 (Ms-it; 
 
 
 
 
 -i- 
 
 
 
 
 t;-i;t-ii; 
 
 14,:. 
 
 .'iD.n 
 
 v,.\:, 
 
 
 
 
 
 
 t;-2(i-iti 
 
 
 
 
 + 
 
 
 
 
 ti-;ii-iii 
 
 14..-. 
 
 38.8:) 
 
 42.26 
 
 + 
 
 
 
 
 n-22-it; 
 
 
 
 
 
 — 
 
 
 i;-2:3-it; 
 
 
 
 
 + 
 
 
 
 
 i;-24-iti 
 
 i:;.7 
 
 44. 3t! 
 
 51.42 
 
 + 
 
 
 
 
 ti-25-16 
 
 
 
 
 + 
 
 
 
 
 ti-26-l(i 
 
 
 
 
 + 
 
 + 
 
 
 (;-2T-l(> 
 
 
 
 
 + 
 
 + 
 
 
 i;-2K.16 
 
 i;i. 
 
 ;!7.42 
 
 40.19 
 
 + 
 
 + 
 
 
 \\ lirii till' 1 r^'aliiiciit is iiiti/iisi\(' ali<aiosis rr- 
 siills, a roiitlilioM luit little studiril ami little 
 midrrstootl. ('Iiart J ilhist fates the f,n'adiial 
 ile\-(do|iiiii'iit of acido.sis and of all<alosis as the 
 ifsult res|"'i-li\'ely of slow adiiiinisl ral i<iii iii- 
 tia\ciioiisly of !;• IK'I and .")', N'alK.'O^^ 
 i )iatli r''sidtcd in hotli instaiiees. 
 
 i'lic usual i-liniral ell'ecls of alkaline tn-at- 
 nnuit ai'i' relirf of dyspnora, diui'esis, with oera- 
 sioiially mental iiniiroNcnient. With letiial 
 ainoutits oi' alkali eoaise tremors and rij^idity 
 di'\('lo|i and linally xomitinfr, eonvulsions, and 
 relaxation of the sphinetHis l;i<j:or moi'tis is 
 inimediale and extreiiie. 
 
 ( linii'all\ at t inirs oedema and aseiirs devtdop 
 durini,' alkali adniinislrati(U). .\side from al- 
 kali therapN' alkalosis is rarely eneountered. 
 \.r\\ ami I have found it only in thi> following: 
 (•oiiditions typhoid, followintr transfusion in 
 prnnar>- and secoiid:ir>' anemia and in nephritis 
 
 :>i 
 
Wilson nnd Pti'iiiiis (14: (IciiioiistratiMl its 
 lifi'sence in cx|ioriiih'ii1;illy iiiduceil tiMniiy in 
 (logs. 
 
 At tlio i)resunt time it must he admitted that 
 our knowlcdtjro of aui<losis is not pi'ot'ound. Re- 
 latively simple methods of deteriiiining its ex- 
 istence and intensity are now available — the 
 same methods serving for the eontrol of ther- 
 apy, 'riirongh their use a dei'per nudei'stand- 
 itiL' iif aciilosis must I'i'siili. Moi-c exact, and 
 
 therefore iiuu'e ell'cctive. Ircatmeiif can 1 on- 
 
 lidently aniieipated. 
 
 € 
 
 UIBLIOORAI'HY. 
 
 Honilevson, L. .1.: Das (Ileichgew ieht zwischeii 
 Itasen und Siiuren iin tiiMsclicn OrKanisnm.s. 
 Ergl). (1. I'h.vsiol., li>ii!i, viji, p. 2.' I. 
 
 Sellai'ds, ,\. W.: Tlio (Iclpriiiiiiali .ii of the ('(|iii- 
 liliriuiii in the luiiiian lioily lie ,eoii iicids ami 
 liases, Willi siioiial reterc'u lo aeidosi.s and 
 iiephropattiies. .Johns Hop. Hosp. Tliill . 101?, 
 xxiii. p. 2S0. 
 
 Scllard.-^. A. \V,: A clinical ni.'lluid lor .^lud>iii^' 
 titratalile alkalinity ol' the blood and its aiipli- 
 cation to acidosis. Ibid,, liUI, xxv, ji. 101. 
 
 I'alnicr anil Ilendei.-on; Clinical studies on 
 acid-base (Mjuilibiiuni and the nature of a<'i- 
 dosis. Arch of Int. .Med.. l!M:i. xij, p. l."i:l. 
 
 Talihcr and lleiiderscn: dn the extroiiies of 
 xarialion of the concentration of ionized hy- 
 di(if;en in huniaii urine. Jour. Uiol. Chemistry, 
 l'.)i:i, xiv, p. !."■:!. 
 
 llnldaiie and l'rie-lle>: .lour. I'hysiol., lite.'., 
 xxxii, p. '22'k 
 
 llaldano and I'oulton: Ibid., 11)08, xxxvii, p. 390. 
 
 Haldane aiul Hoyrott : Ibid, lOii.S, xxxvii, p. lifin. 
 
 Haldane and n<iUKlas; Ibid, l',to:t, xxxviii, p. 420. 
 
 •In alluU'isis the CO ol IiIocmI and nf tin- alv 'olar 
 air are widely dl\erKcnt. 
 
 'I'llP writer wishes to acKiiowledte his indebted 
 nt'SS to Miss Winnifred Swifl for valuable technical 
 assifitaurc. 
 
11'. 
 
 i:;. 
 
 II 
 
 I"ridpiiri,-i ; ICinc klinische ifctliode zur Bestim- 
 iiiuiiR (ler Kolilensiiurespannung in der Lun- 
 wnliift. liprlin klin. AVochen., lOH, li (2), p. 
 
 1268. 
 
 I'lescli Method df obtainiiiK alveolar air. Zeit. 
 1'. exii. I'alh. u. Tlierap., 11109, vi, p. 3S0. 
 
 I'eabody: Clinical Studies on Respiration. No. 
 I, The Kfl'e( t of CO. in the inspired air on pa- 
 lients with caidiac diseaj^e An h. of Int. 
 Med., .Nov. I.'., 1913, p. S4«. 
 
 liarcroft: The l{esi)irator.v Function of ihe 
 Blood. Cambridge Cniversity I'less, 1914. 
 
 .Sihafl'er aiul Marriott: The determination of 
 acetone. .Nephelometric determination of min- 
 ute ipiantitie.s of acetone. The determination 
 or 11. ox.N butyric acid in blood and ti.ssiie.s. 
 Jour, Hiol. Clieni., 1913, .\vl, p. 26."!. 
 
 -Marrioii: The blood in acidosis froui the ipian- 
 titative .standiioint. ,Iour. r.iiil. Cheiu., 1911, 
 xviii, p. ."jOT. 
 
 Hov.land and Marijoti: .\cidosis occurring with 
 diarrhoeas, American .lour, of l)is. ol Chil- 
 dren, Vol. xi. .No. Ti, p. 309. 
 
 SclUiiils: Tolerance toi alKalie.s in .^.siatic Cho- 
 lera. I'hiiippine Jour rfi ience. 191'i. v. ;iu3. 
 
 Sellards and yiiaKlee: Indications of acid intox- 
 ication in Ahiatic cholera. Ibid,, 1911, vi, p. 53 
 
 llasselbahh and Cammeltoft: Die .Veutralitats 
 refzulation des gi aviden Oiganismus. Hiochem 
 Zeit.. 191,'.. Ixviii. p. 2u!>. .Abstracted in ,lour 
 A. M, A, Oct 2, 191.", Ixv, p, ll9i.i, 
 
 l\hrnjaiin and Ksser: Ceber experimentalles 
 Kdnia. Zeitschr. f. klin. Med., Vol. 72. 1911, p 
 49«. 
 
 Wilson and Stearns: 'I'he cITect of a<id admin 
 islration on luiratliyroid tetany. Jour, liijl 
 
 Chem , 191.'.. xxi, .i,!i. 
 
 23